biostudies-literaturePalacios-Baena ZRNational Institute of Allergy and Infectious DiseasesNIAID NIH HHSNational Institutes of Health1615-1623https://www.ebi.ac.uk/biostudies/studies/S-EPMC5849995biostudies-literatureUnknown65(10)<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.Clinical infectious diseases : an official publication of the Infectious Diseases Society of AmericaEmpiric Therapy With Carbapenem-Sparing Regimens for Bloodstream Infections due to Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae: Results From the INCREMENT Cohort.PMC5849995R01 AI063517R01AI072219 and R01AI063517R01 AI072219Pintado VRuiz-Garbajosa POliver AGonzalez VMachuca ICalbo ETacconelli Ede la Calle CMolina JAlmela MGalvez JMolina Gil-Bermejo JPrim NFarinas MCHamprecht ACano MEHsueh PRAntoniadou ABou GAzap OKVirmani DHernandez ARusso AGozalo MTuon FFRoilides EAkova MDoi YFalcone MKaraiskos IRodriguez-Bano JPascual AVenditti MTsakris ABadia CBermejo JRuiz de Gopegui EPalacios-Baena ZRLowman WAlmirante BMartinez-Martinez LFontanals DSahin AOCarmeli YSan Juan RPeter STorre-Cisneros JPano-Pardo JRPitout JPournaras SMartinez JAGiannella MSchwaber MJSouli MPuig MViale PPerez FNavarro FMirelis BDaikos GGomez-Zorrilla SFernandez-Ruiz MTumbarello MJove EPoulakou GMorata LMora-Rillo MPena CGasch OBonomo RAGiamarellou HBartoletti MGomez JXercavins MPaterson DLGutierrez-Gutierrez BLarrosa NTrecarichi EMIosifidis EHelvaci OMarinescu CIRucci VZarkotou OSpanish Network for Research in Infectious DiseasesTubau FLosito ARCano AfalseEmpiric Therapy With Carbapenem-Sparing Regimens for Bloodstream Infections due to Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae: Results From the INCREMENT Cohort.<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.2017-01-01T00:00:00Z2017 Oct2026-05-02T06:49:26.274Z2026-04-07T17:42:11.477ZS-EPMC58499952902025010.1093/cid/cix606