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dc.contributor.authorGutierrez-Gutierrez, Belen
dc.contributor.authorPerez-Galera, Salvador
dc.contributor.authorSalamanca, Elena
dc.contributor.authorde Cueto, Marina
dc.contributor.authorCalbo, Esther
dc.contributor.authorAlmirante, Benito
dc.contributor.authorViale, Pierluigi
dc.contributor.authorOliver, Antonio
dc.contributor.authorPintado, Vicente
dc.contributor.authorGasch, Oriol
dc.contributor.authorMartinez-Martinez, Luis
dc.contributor.authorPitout, Johann
dc.contributor.authorAkova, Murat
dc.contributor.authorPena, Carmen
dc.contributor.authorMolina, Jose
dc.contributor.authorHernandez, Alicia
dc.contributor.authorVenditti, Mario
dc.contributor.authorPrim, Nuria
dc.contributor.authorOriguen, Julia
dc.contributor.authorBou, German
dc.contributor.authorTacconelli, Evelina
dc.contributor.authorTumbarello, Mario
dc.contributor.authorHamprecht, Axel
dc.contributor.authorGiamarellou, Helen
dc.contributor.authorAlmela, Manel
dc.contributor.authorPerez, Federico
dc.contributor.authorSchwaber, Mitchell J.
dc.contributor.authorBermejo, Joaquin
dc.contributor.authorLowman, Warren
dc.contributor.authorHsueh, Po-Ren
dc.contributor.authorMora-Rillo, Marta
dc.contributor.authorNatera, Clara
dc.contributor.authorSouli, Maria
dc.contributor.authorBonomo, Robert A.
dc.contributor.authorCarmeli, Yehuda
dc.contributor.authorPaterson, David L.
dc.contributor.authorPascual, Alvaro
dc.contributor.authorRodriguez-Bano, Jesus
dc.date.accessioned2019-12-10T11:10:04Z
dc.date.available2019-12-10T11:10:04Z
dc.date.issued2016
dc.identifier.issn0066-4804
dc.identifier.urihttps://doi.org/10.1128/AAC.00365-16
dc.identifier.urihttp://hdl.handle.net/11655/14802
dc.description.abstractThe spread of extended-spectrum-beta-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) is leading to increased carbapenem consumption. Alternatives to carbapenems need to be investigated. We investigated whether beta-lactam/beta-lactamase inhibitor (BLBLI) combinations are as effective as carbapenems in the treatment of bloodstream infections (BSI) due to ESBL-E. A multinational, retrospective cohort study was performed. Patients with monomicrobial BSI due to ESBL-E were studied; specific criteria were applied for inclusion of patients in the empirical-therapy (ET) cohort (ETC; 365 patients), targeted-therapy (TT) cohort (TTC; 601 patients), and global cohort (GC; 627 patients). The main outcome variables were cure/improvement rate at day 14 and all-cause 30-day mortality. Multivariate analysis, propensity scores (PS), and sensitivity analyses were used to control for confounding. The cure/improvement rates with BLBLIs and carbapenems were 80.0% and 78.9% in the ETC and 90.2% and 85.5% in the TTC, respectively. The 30-day mortality rates were 17.6% and 20% in the ETC and 9.8% and 13.9% in the TTC, respectively. The adjusted odds ratio (OR) (95% confidence interval [CI]) values for cure/improvement rate with ET with BLBLIs were 1.37 (0.69 to 2.76); for TT, they were 1.61 (0.58 to 4.86). Regarding 30-day mortality, the adjusted OR (95% CI) values were 0.55 (0.25 to 1.18) for ET and 0.59 (0.19 to 1.71) for TT. The results were consistent in all subgroups studied, in a stratified analysis according to quartiles of PS, in PS-matched cases, and in the GC. BLBLIs, if active in vitro, appear to be as effective as carbapenems for ET and TT of BSI due to ESLB-E regardless of the source and specific species. These data may help to avoid the overuse of carbapenems. (This study has been registered at ClinicalTrials.gov under registration no. NCT01764490.)
dc.language.isoen
dc.publisherAmer Soc Microbiology
dc.relation.isversionof10.1128/AAC.00365-16
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectMicrobiology
dc.subjectPharmacology & Pharmacy
dc.titleA Multinational, Preregistered Cohort Study Of Beta-Lactam/Beta-Lactamase Inhibitor Combinations For Treatment Of Bloodstream Infections Due To Extended-Spectrum-Beta-Lactamase-Producing Enterobacteriaceae
dc.typeinfo:eu-repo/semantics/article
dc.typeinfo:eu-repo/semantics/publishedVersion
dc.relation.journalAntimicrobial Agents And Chemotherapy
dc.contributor.departmentİç Hastalıkları
dc.identifier.volume60
dc.identifier.issue7
dc.identifier.startpage4159
dc.identifier.endpage4169
dc.description.indexWoS
dc.description.indexScopus


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