Use of non-carbapenem antibiotics to treat severe extended-spectrum ß-lactamase-producing Enterobacteriaceae infections in intensive care unit patients.
Int J Antimicrob Agents
; 53(5): 547-552, 2019 May.
Article
em En
| MEDLINE
| ID: mdl-30742956
ABSTRACT
OBJECTIVES:
The aim of this study was to evaluate the use of non-carbapenem antibiotics to treat severe extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBL-E) infections in intensive care unit (ICU) patients.METHODS:
This retrospective observational study conducted in two ICUs compared the outcomes of patients with ESBL-E infections administered a carbapenem or a non-carbapenem antibiotic as their definitive treatment. The primary outcome was treatment failure within 30 days, a composite endpoint of ESBL-E infection recurrence and 30-day mortality. Secondary outcomes included 30-day and in-hospital mortality rates, ESBL-E infection recurrence and infection(s) due to other pathogen(s).RESULTS:
Among 107 patients included in the study, 67 received a carbapenem and 40 received a non-carbapenem antibiotic as their definitive treatment. Clinical characteristics of the two groups were similar. Comparing patients given a non-carbapenem antibiotic with those administered a carbapenem, they had similar 30-day treatment failure (43% vs. 61%, respectively; Pâ¯=â¯0.06) and ESBL-E infection recurrence rates (25% vs. 22%; Pâ¯=â¯0.8), but the former had lower 30-day mortality (23% vs. 45%; Pâ¯=â¯0.02) and in-hospital mortality rates (23% vs. 49%; Pâ¯=â¯0.005). Secondary infection rates caused by other pathogen(s), including Clostridium difficile, were comparable. Outcomes were comparable regardless of whether or not patients received an empirical carbapenem.CONCLUSION:
For ICU patients with severe ESBL-E infections, treatment with a non-carbapenem antibiotic was not associated with poorer outcomes compared with a carbapenem antibiotic.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Beta-Lactamases
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Estado Terminal
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Enterobacteriaceae
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Infecções por Enterobacteriaceae
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Antibacterianos
Tipo de estudo:
Observational_studies
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Risk_factors_studies
Limite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article