TY - JOUR
T1 - Comparison between carbapenems and β-lactam/β- lactamase inhibitors in the treatment for bloodstream infections caused by extended-spectrum β-lactamase- producing Enterobacteriaceae
T2 - A systematic review and meta-analysis
AU - Muhammed, Maged
AU - Flokas, Myrto Eleni
AU - Detsis, Marios
AU - Alevizakos, Michail
AU - Mylonakis, Eleftherios
N1 - Publisher Copyright:
© The Author 2017.
PY - 2017/3/1
Y1 - 2017/3/1
N2 - Background. Carbapenems are widely used for the management of bloodstream infections (BSIs) caused by extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE). However, the wide use of carbapenems has been associated with carbapenem- resistant Enterobacteriaceae development. Methods. We searched the PubMed and Scopus databases (last search date was on June 1, 2016) looking for studies that reported mortality in adult patients with ESBL-PE BSIs that were treated with carbapenems or β-lactam/β-lactamase inhibitors (BL/BLIs). Results. Fourteen studies reported mortality data in adult patients with ESBL-PE BSI that were treated with carbapenems or BL/ BLIs. Among them, 13 studies reported extractable data on empiric therapy, with no statistically significant difference in mortality of patients with ESBL-PE BSI that were treated empirically with carbapenems (22.1%; 121 of 547), compared with those that received empiric BL/BLIs (20.5%; 109 of 531; relative risk [RR], 1.05; 95% confidence interval [CI], 0.83-1.37; I2 = 20.7%; P = .241). In addition, 7 studies reported data on definitive therapy. In total, 767 patients (79.3%) received carbapenems and 199 patients (20.6%) received BL/BLIs as definitive therapy, and there was again no statistically significant difference (RR, 0.62; 95% CI, 0.25-1.52; I2 = 84.6%; P < .001). Regarding specific pathogens, the use of empiric BL/BLIs in patients with BSI due to ESBL-Escherichia coli was not associated with a statistically significant difference in mortality (RR, 1.014; 95% CI, 0.491-2.095; I2 = 62.5%; P = .046), compared with the use of empiric carbapenems. Conclusions. These data do not support the wide use of carbapenems as empiric therapy, and BL/BLIs might be effective agents for initial/empiric therapy for patients with BSI caused by likely ESBL-PE, and especially ESBL-E coli.
AB - Background. Carbapenems are widely used for the management of bloodstream infections (BSIs) caused by extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE). However, the wide use of carbapenems has been associated with carbapenem- resistant Enterobacteriaceae development. Methods. We searched the PubMed and Scopus databases (last search date was on June 1, 2016) looking for studies that reported mortality in adult patients with ESBL-PE BSIs that were treated with carbapenems or β-lactam/β-lactamase inhibitors (BL/BLIs). Results. Fourteen studies reported mortality data in adult patients with ESBL-PE BSI that were treated with carbapenems or BL/ BLIs. Among them, 13 studies reported extractable data on empiric therapy, with no statistically significant difference in mortality of patients with ESBL-PE BSI that were treated empirically with carbapenems (22.1%; 121 of 547), compared with those that received empiric BL/BLIs (20.5%; 109 of 531; relative risk [RR], 1.05; 95% confidence interval [CI], 0.83-1.37; I2 = 20.7%; P = .241). In addition, 7 studies reported data on definitive therapy. In total, 767 patients (79.3%) received carbapenems and 199 patients (20.6%) received BL/BLIs as definitive therapy, and there was again no statistically significant difference (RR, 0.62; 95% CI, 0.25-1.52; I2 = 84.6%; P < .001). Regarding specific pathogens, the use of empiric BL/BLIs in patients with BSI due to ESBL-Escherichia coli was not associated with a statistically significant difference in mortality (RR, 1.014; 95% CI, 0.491-2.095; I2 = 62.5%; P = .046), compared with the use of empiric carbapenems. Conclusions. These data do not support the wide use of carbapenems as empiric therapy, and BL/BLIs might be effective agents for initial/empiric therapy for patients with BSI caused by likely ESBL-PE, and especially ESBL-E coli.
KW - Bloodstream infection (BSI)
KW - Carbapenems
KW - Extended-spectrum β-lactamase (ESBL)
KW - β-lactam/β-lactamase inhibitor (BL/BLIs)
UR - http://www.scopus.com/inward/record.url?scp=85030612292&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85030612292&partnerID=8YFLogxK
U2 - 10.1093/ofid/ofx099
DO - 10.1093/ofid/ofx099
M3 - Article
AN - SCOPUS:85030612292
SN - 2328-8957
VL - 4
JO - Open Forum Infectious Diseases
JF - Open Forum Infectious Diseases
IS - 2
M1 - ofx099
ER -