Please use this identifier to cite or link to this item:http://hdl.handle.net/20.500.12105/20493
Title
Geographical variation in therapy for bloodstream infections due to multidrug-resistant Enterobacteriaceae: a post-hoc analysis of the INCREMENT study
Author(s)
Harris, Patrick NA | Pezzani, M. Diletta | Gutierrez-Gutierrez, Belen | Viale, Pierluigi | Hsueh, Po-Ren | Ruiz-Garbajosa, Patricia | Venditti, Mario | Tumbarello, Mario | Navarro-Francisco, Carolina | Calbo, Esther | Akova, Murat | Giamarellou, Helen | Oliver, Antonio | Almirante, Benito | Gasch, Oriol | Martinez-Martinez, Luis | Schwaber, Mitchell J | Daikos, George | Pitout, Johann | Pena, Carmen | Hernandez-Torres, Alicia | Doi, Yohei | Perez, Federico | Tuon, Felipe Francisco | Tacconelli, Evelina | Carmeli, Yehuda | Bonomo, Robert A | Pascual, Alvaro | Paterson, David L | Rodriguez-Bano, Jesus | ESGBIS Grp | REIPI Grp | INCREMENT Grp
Date issued
2017-11
Citation
Harris Patrick N. A., Pezzani M. Diletta, Gutierrez-Gutierrez Belen, Viale Pierluigi, Hsueh Po-Ren, Ruiz-Garbajosa Patricia, et al. Geographical variation in therapy for bloodstream infections due to multidrug-resistant Enterobacteriaceae: a post-hoc analysis of the INCREMENT study. Int J Antimicrob Agents. 2017 Nov;50(5):664-672. Epub 2017 Aug 3.
Language
Inglés
Document type
research article
Abstract
We describe regional differences in therapy for bloodstream infection (BSI) caused by extended-spectrum beta-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 beta-lactam/beta-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 1.053.39) 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.
Subject
Extended-spectrum beta-lactamase | Carbapenemase | Carbapenems | beta-Lactam/beta-lactamase inhibitor | Escherichia coli | Klebsiella pneumoniae
MESH
Aged, 80 and over | Aged | Drug Resistance, Multiple, Bacterial | Enterobacteriaceae Infections | Adult | Humans | Enterobacteriaceae | Middle Aged | Global Health | Male | Female | Sepsis | beta-Lactamase Inhibitors | beta-Lactams | Retrospective Studies
DECS
Farmacorresistencia Bacteriana Múltiple | Salud Global | Femenino | Sepsis | Masculino | Enterobacteriaceae | Infecciones por Enterobacteriaceae | Humanos | Persona de Mediana Edad | Anciano | Anciano de 80 o más Años | Inhibidores de beta-Lactamasas | beta-Lactamas | Estudios Retrospectivos | Adulto
Online version
DOI
Collections
- Investigación > IIS > IdisBa - Instituto de Investigación Sanitaria Illes Balears (Baleares)
- Investigación > IIS > IDIVAL - Instituto de Investigación Marqués de Valdecilla (Cantabria)
- Investigación > IIS > IMIBIC - Instituto Maimónides de Investigación Biomédica de Córdoba (Andalucía)
- Investigación > IIS > IBIS - Instituto de Biomedicina de Sevilla (Andalucía)
- Investigación > IIS > IdiPAZ - Instituto de Investigación Sanitaria Hospital La Paz (Madrid)
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